Registered infections of covid-19 rose above 40 million on Monday, but the incidence of the disease is by no means homogeneous: while Europe is already suffering the effects of the second wave of infections, China, the country where the pandemic originated, has the coronavirus practically under control. In contrast, India and the United States are still suffering the first wave. Paediatrician and epidemiologist Quique Bassat, who works as a researcher at ISGlobal, analyses the state of the pandemic in the world.
Europe is at the beginning of a second wave of covid-19. Is this, right now, the main focus of the pandemic?
Europe is a very constant focus: all the countries have worsened more or less in a similar way, except for honorable exceptions such as Italy, which, despite being one of the countries that suffered most in the first wave, is one of those that have done better later on. Germany, which has about 2,000 new cases every day, is not the same as Spain, which has about 12,000, but throughout Europe the numbers are rising worryingly. Therefore, as a continent we are doing badly, but we are not the worst off: India has 50,000 new cases every day, and that is despite all the under-diagnosis that there must be, because they are not doing all the tests that would be necessary. But, of course, we are talking almost about a continent in itself.
India's population is 1.3 billion. In proportion, 50,000 cases a day are not that many.
Yes, in relative terms they're better off than we are. But, in absolute numbers, India is the major contributor to the increase in daily cases.
And what areas of the world are currently best off?
Asia, with the exception of the Indian subcontinent, is the continent that is most peaceful.
China, the country of origin of the coronavirus, now has very few new cases. How have they managed to avoid the second wave?
They didn't let it come. In the city of Qingdao, with a population of nine million, they had 12 cases and in five days they tested all nine million inhabitants. This is a military approach to public health that obviously works very well, but not all countries can implement it. In addition, and this is also the case in India, there is a very strict restriction on entering the country: even Chinese citizens need a special permit. If you do this it is easier to control the situation, but it requires an effort and a budget that you have to be willing to spend.
On the other hand, countries like the United States or Brazil have not yet managed to overcome the first wave, have they?
They are now getting towards the end of the first wave, just like India. But in such large countries it is possible that, if you break the data down by cities or by regions, you start to see second waves. In the United States it has not affected all the states equally: some started out very strong, like New York, which came to have more cases than some European countries but is now very quiet, while other American states are now in a very bad situation. This also happens in India or Brazil. What we are seeing is that the peak of the first waves has not taken place at the same time throughout the country. It is also true that Brazil, which used to be the country where the virus was strongest, is now calmer. However, they have reached situations in cities like Manaus, in the Amazon, where it is estimated that half the population has been infected. Here it's difficult to see the numbers continue to rise because most people are already immunised.
Does the different impact of the virus in different areas depend exclusively on the measures taken, or is it influenced in any way by the behaviour of the virus itself?
The virus is the same, it does not change the virulence or the way it is transmitted. What changes are the prevention measures that are put in place and how well they are followed by the community. If you have a state in the United States that is predominantly inhabited by denialists, who don't believe in the use of masks or that the virus is a reality, they won't follow the recommendations well and there will be a spike earlier than in places where advice is followed. But, once you have greater community transmission, either everyone gets their act together or it's difficult to control it and avoid a spike.
So, was this second wave avoidable?
Absolutely. We expected it in the autumn. It's now autumn and we're in the middle of it. However, it started in the summer in some places and we didn't do what we had to do. At first, Spain probably exited the lockdown too early and too fast, with phases gradually shortened phases: the plan was very well thought out, but the reality was different. And then, in summer, there were few cases and we thought it was all over, so we lowered our guard and did things that favoured the return of the virus.
Is it possible that the second wave that we are now experiencing here, in a few weeks' time, will move to other countries where the incidence is now lower? Or is the virus already everywhere?
The virus is spread everywhere but it is quite controlled in some places. Second waves are usually quite inevitable unless you have a vaccine, but there are countries and governments that have understood what had to be done and are doing it. The example of Italy is one of the best: they were one of the most affected initially in Europe and they have now managed better. The Portuguese are also a good example of this: they have not been very affected and are by our side, it is quite amazing. If you think it will not happen to you and don't take the appropriate measures, then that what is happening to us will happen to you. At the beginning of the pandemic, the director of the WHO said it was crucial to do tests - and we are not doing them. I can't believe that we can't do things here similar to the nine million tests that have been done in China. And, besides, we were promised that this would come, and it hasn't! Considering that many infections do not cause symptoms, if we do not look for them we will not find them.
Can this second wave end up in the same situation as the one in March and April?
I'd like to think we've learned something from that tragedy. There is a very big difference: in absolute terms the figures are similar, but in the first wave we only detected the tip of the iceberg and missed all the infections that caused few symptoms; now, however, we do not have all the tests that we should have but we are detecting many more infections between contacts. So it is true that the numbers are very scary and there is a rising trend, but many of these infections we are detecting are mild and the risk of saturation of the health system is smaller than we had with the same number of cases in the first wave. But, well, if the upward trend continues, there will come a time when the system will be saturated anyway, and hospitals are already beginning to be very full.